Prescription for heartache

With close to 2 million Americans dependent on or abusing prescription painkillers, a growing number of families are redefining their notions of what a drug addict looks like.

"The person with the drug problem is not necessarily a teenager shooting up in a dark alley or snorting cocaine at an all-night party," writes Barbara Gordon in "I'm Dancing as Fast as I Can" (Beaufort Books), her newly re-released memoir of a life unraveled by addiction to prescription drugs. "It may be a woman turned out in an elegant suit and flawless makeup, who carries an attache case as she clicks her way down an office hallway in stiletto heels to attend a meeting."

Indeed, painkiller overdoses now account for more than twice the deaths as cocaine and five times as many as heroin, according to the Centers for Disease Control and Prevention. A 2009 National Survey on Drug Use and Health by Columbia University found that the proportion of Americans addicted to opioids — Oxycontin, Vicodin, Demerol — tripled from 1991 to 2001. (The same study determined the aforementioned 2 million figure.)

Opioids, according to a recent report in the Harvard Medical School health briefing, create a euphoric feeling by targeting the same brain receptors as heroin, which is why they're so highly addictive. They are prescribed to treat both severe, short-term acute pain and chronic conditions, such as arthritis, migraines and pain caused by cancer.

Even as the face of addiction changes, so does our understanding of how best to help treat it. That the drugs often originate in a doctor's office or pharmacy makes them no less lethal. And when the addict is your spouse or partner, determining the best course of action takes on an added urgency.

Each case of addiction and each family will have its own complications and nuances, of course. But if you've recently discovered that your partner is struggling with a prescription drug addiction, experts have a road map for you.

Step in immediately. "It's no longer assumed you should let the person hit rock bottom and experience enough consequences to see what they're doing," says Lisa Najavits, professor of psychiatry at Boston University School of Medicine. "The majority of addicts — 60 percent — have one or more co-occurring mental health issues. So you may see the addiction very prominently, but what's hidden are all kinds of disorders co-occurring that need to be addressed immediately."

Adopt an active role. Psychologist Robert J. Meyers developed the CRAFT (Community Reinforcement Approach and Family Training) approach to intervention, which posits that family members play a powerful role in persuading substance abusers to submit to treatment.

After all, the whole family suffers from the addiction and also benefits from the treatment of it, says Sherry Knapp-Brown, staff psychologist at the Lindner Center of Hope, a Mason, Ohio, hospital specializing in the treatment of mental disorders and addictions.

"The gist of the CRAFT model is to really look at what the motivators are and how you can, as a spouse or family member, help lessen some of those motivators in their life," says Knapp-Brown. "And how you can try to encourage them to see the value of seeking treatment."

That may mean researching treatment centers, rearranging family schedules to accommodate counseling sessions and providing transportation to and from appointments.

"One of the biggest myths around addiction is the old school treatment, which is that someone has to be motivated on their own or they won't get better," Najavits says. "We now know that any way an addicted person enters treatment can be a good way. Getting them in the door is what produces positive outcomes, and people who are mandated to be there do just as well as those who come voluntarily."

Find tailored help. A prescription drug addiction shares many similarities with alcohol or other drug addictions. But there are some key differences. "With people who are misusing prescription drugs, there can be risks to withdrawing from them," Knapp-Brown says. "That may have to be considered as part of the treatment, so you want to make sure that's something you handle with a medical professional."

Don't lose yourself. "Because the symptoms and problems may be so dramatic and visible, it can pull other family members to ignore their own needs," Najavits says. "It's crucial for the family and each person within it not to get lost in an attempt to help. They need to focus on their own self-care and set their own boundaries and even seek professional counseling if they feel it's needed."

And if the addiction is fueling a cycle of abuse, seek protection.

"Especially early on, it's very worth seeing what you can do to help," Knapp-Brown says. "But if it's gotten to the point where the person has drained your finances or is engaging in any physical violence, it may be time to just get out. You have to look out for your own safety and welfare."

But know that you can help. "With good treatment, many people do recover," Najavits says. "It's important to get real professional advice and educate the family as much as possible. The reality is if the person gets treatment and really works at it, they can get better."